Value-Based Care Metrics: How To Measure the Success of Your Program

Key Takeaways:

• Success in value-based care requires measuring process, outcomes, experience, and cost together.

• Process measures show if care is proactive, consistent, and safe.

• Outcome measures reveal whether care truly improves patient health and reduces readmissions.

• Patient experience metrics capture trust, engagement, and satisfaction across touchpoints.

• AI lightens the administrative load so providers can focus on delivering better value-based care.

You can’t run a successful value-based care (VBC) program without measuring performance. But most revenue cycle teams don’t realize it’s not as simple as tracking outcomes on a spreadsheet.

You know outcomes matter. You know patient experience matters. But turning those goals into numbers you can track, report, and actually act on? That’s where it gets complicated.

We’ve seen organizations struggle with fragmented data, lagging insights, and measurement frameworks that don’t account for the complexity of their patients.

If you're navigating the shift from volume to value and want to make sure your measurement strategy is more than a checkbox exercise, this blog post is just for you! 

We’ve broken down the core value-based care metrics that actually move the needle, so you can measure progress, close gaps, and drive better results across your patient population.

Also read: Fee for service vs Value-based care

Key Value-Based Care Metrics to Measure

Not every data point is created equal, and chasing the wrong metrics can waste time without improving outcomes.

To help you focus your efforts, we’ve organized the most important value-based care metrics into four clear categories:

1. Process measures
2. Outcome measures
3. Patient experience measures
4. Cost and utilization measure

But first, here’s a TL;DR version of value-based care metrics you should know of:

Process Measures

Process measures evaluate the “how” of value-based care. This includes:

• How consistently are your providers following clinical guidelines
• How often are preventive services offered
• How well workflows are designed to catch issues early.

Example: Percentage of patients up to date with colorectal cancer screenings of receiving their annual flu shots

The typical metrics falling under process measures include:

1. Care Coordination

Care coordination measures how effectively healthcare providers communicate and work together to deliver a patient’s care. It’s about connecting the dots (primary care, specialists, labs, and post-acute care), so nothing falls through the cracks.

How it’s tracked:

• Percentage of patients with a documented care plan
• Timely communication between providers after hospital discharge
• Follow-up rates on referrals to specialists

2. Preventive Care Engagement

This measures how consistently patients receive preventive services such as vaccinations, screenings, and lifestyle counseling. It’s a way to see if care is proactive rather than reactive.

How it’s tracked:

• Percentage of eligible patients receiving their annual shots or screenings
• Participation rates in wellness programs or preventive health assessments
• Adherence to recommended vaccination schedules

3. Timeliness

Timeliness measures how quickly patients receive the care they need without unnecessary delays. That’s because delays can worsen outcomes, increase patient anxiety, and lead to costly interventions later.

Here’s what to track:

• Average wait time for appointments
• Time from hospital discharge to follow-up visit
• Turnaround time for lab results or diagnostic testing

4. Safety

Safety metrics track the prevention of harm to patients during care. This includes avoiding medical errors, infections, falls, and medication-related mistakes.

Key safety metrics to track:

• Rates of hospital-acquired infections
• Incidence of adverse drug events or medication errors
• Number of falls or other preventable injuries in clinical settings

Outcome Measures

Outcome measures ask the more important question: “Did it actually make a difference in the patient’s health?”

These measures reflect the clinical effectiveness, safety, and patient-centeredness of care.

Outcome measures help you answer:

• Did the treatment improve a patient’s condition?
• Did it prevent unnecessary hospitalizations?
• Did patients feel better, function better, or live longer?

Here are the value-based care metrics to measure as part of tracking outcomes:

1. Improvements in chronic disease management

One of the clearest signs of success in VBC is whether patients with chronic conditions are staying stable or improving.

Example:

A lower HbA1c in diabetic patients means fewer complications, fewer ER visits, and better quality of life.

2. Hospital readmission rates improvements

Hospital readmissions are costly and often preventable. That’s why they’re a key outcome metric in Medicare’s value-based care contracts.

Real-world examples of health centers tracking readmission rates

1. Muskingum Valley Health Centers (MVHC) actively tracks and reduces all-cause 30-day readmissions, recognizing that timely follow-up can prevent bounce-backs.

2. Hattiesburg Clinic’s Transitional Care Management (TCM) services reduced readmissions by 30% within 30 days of discharge, largely by reaching patients early and addressing post-discharge needs.

To understand clinical gaps and operational delays, track these metrics:

• 30-day all-cause readmission rate
• Post-discharge follow-up within 7 days
• ED visit rates per 1,000 patients

3. Patient-reported outcomes (PROs)

Clinical stats don’t always capture what matters most to patients: function, pain, mental well-being, and daily living. That’s where PROs help capture how patients feel and function, directly from the patients themselves—whether it’s physical pain, mental health, mobility, fatigue, or social functioning.  

PROs are collected through validated surveys and disease-specific tools, such as:

• PROMIS (to measure general physical, mental, and social health)
• PHQ-9 (to measure depression symptoms and severity)
• HOOS/KOOS (to assess pain, stiffness, daily function post-surgery)
• Visual analog scale for pain intensity

Patient Experience Measures

Patient experience measures assess how individuals perceive the care they receive across various touchpoints in the system. These metrics focus on communication quality, access to services, care coordination, and responsiveness—factors that influence both clinical outcomes and long-term patient engagement.

While not clinical in nature, these measures are directly linked to quality performance in many value-based care models. Health systems use them to identify service gaps, strengthen patient trust, and meet contractual requirements tied to satisfaction and engagement.

Real-World Examples

Hattiesburg Clinic has reported high patient satisfaction, especially around their post-discharge care program, which delivers timely follow-ups in the patient’s home. This builds trust, reduces confusion, and helps avoid costly readmissions.

CMS uses Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores to determine a portion of Medicare Advantage Star Ratings, which directly impact reimbursement and bonuses.

Some key metrics to track:

1. Patient Engagement

Patient engagement measures how actively patients participate in their own healthcare, and health centers have a lot to contribute here. This goes beyond just showing up for appointments—it includes using digital tools, following treatment plans, tracking health metrics, and communicating with providers.

Metrics you should track:

• Frequency of log-ins on patient portals
• Completion of self-monitoring tasks (e.g., blood pressure tracking, glucose logging)
• Participation in care programs or health coaching sessions
• Response rates to health reminders or follow-up messages

2. Patient Access to Care

Patient access measures how easily patients can obtain the care they need when they need it. This includes scheduling appointments, getting timely referrals, and accessing specialists or follow-up services.

How it’s tracked:

• Average wait times for primary care and specialist appointments
• Percentage of patients able to see a provider within a target timeframe
• Availability of telehealth or after-hours care options
• Rates of missed or canceled appointments due to scheduling barriers

3. Provider-Patient Communication

This metric evaluates the clarity, frequency, and responsiveness of communication between patients and healthcare providers. It ensures patients understand their care plan, can ask questions, and receive timely updates.

How it’s tracked:

• Patient survey scores on communication clarity and responsiveness 
• Timely follow-up messages or phone calls after appointments
• Frequency of care plan reviews with patients
• Resolution of patient questions or concerns within a set timeframe

Cost and Utilization Measures

Keeping an eye on costs and utilization is just as important as tracking outcomes. These measures show how efficiently care is delivered and whether resources are being used wisely.

Here’s what matters most:

• Total cost of care per patient: Lowering costs while maintaining quality is the ultimate goal.
• Emergency department (ED) utilization and unplanned admissions: Frequent ED visits and hospital readmissions signal gaps in proactive care.
• Accurate clinical documentation and HCC coding: Proper documentation ensures patients’ health status and risk levels are reflected accurately, and it directly influences financial performance and resource allocation.

Building Blocks of Effective Value-Based Care Implementation

Measuring success in value-based care (VBC) requires the right systems, tools, and strategies to capture what really matters. Below are six foundational principles every healthcare organization should consider when designing or refining their VBC measurement framework:

1. Data Is the Bedrock of Value-Based Care

You can’t improve what you can’t measure, and you can’t measure without solid data. From Electronic Health Records (EHRs) to patient-generated health information from wearables, value-based care depends on comprehensive, accurate, and timely data to track progress and guide decision-making.

Key sources include:

• Clinical data from EHRs
• Claims data to track services delivered
• Patient-generated data (e.g., blood pressure logs, activity tracking)

2. Interoperability Offers The 360-Degree Patient View

One of the biggest challenges in healthcare is fragmented data—patients often receive care across multiple systems, providers, and platforms. Interoperability solves this by ensuring that all health systems and tools can “talk” to each other.

3. Risk Adjustment Is Non-negotiable

Some patients face more complex medical conditions, while others struggle with social challenges like housing, food access, or transportation. That’s why VBC models rely on risk adjustment—a process that ensures providers aren’t unfairly penalized for caring for sicker or more vulnerable patients.

Collecting and using Social Determinants of Health (SDOH) data is key to this, as it allows for:

• Fairer performance comparisons
• Targeted interventions
• Smarter resource allocation

4. Technology Is a Force-Multiplier

Without the right tools in place, even the most well-intentioned programs risk collapsing under the weight of data gaps, communication failures, and delayed interventions.

Here’s what today’s tech can actually do in VBC models (when used well):

• EHRs that work smarter, not harder: While many EHRs were built for fee-for-service billing, they’re now being reshaped to support proactive care. This means better workflows, cleaner documentation, and real-time insights. 
• AI that can spot trouble before it hits: Predictive analytics help identify who's at risk for a hospital visit, a missed screening, or an untreated chronic condition. It’s not magic—it’s math, applied in real time.
  
• Personalized care, minus the guesswork: AI can connect the dots between genetics, environment, and lifestyle to offer treatment plans that actually fit the individual—not a population average.
• Automated admin tasks: AI can now handle repetitive tasks like appointment scheduling, coding, billing, and clinical documentation, so care teams can spend less time doing administrative work.
• Remote care with real-time feedback loops: Devices and monitoring tools track patient vitals outside the clinic, giving providers a running start to intervene early.
• From raw data to real insight: Large Language Models (LLMs) can turn pages of discharge notes, claims, and care summaries into clean, usable intelligence—cutting down hours of chart diving into seconds of clarity.

Ready To Skyrocket Your Value-Based Care Performance With AI?

Tracking the success of a value-based care program isn't just about hitting clinical targets. It’s about delivering consistent, coordinated care—measured not only by outcomes, but by experience, engagement, and efficiency. 

And while the value-based care metrics mentioned in this blog offer a holistic view of performance, managing them can quickly become an administrative burden.

That’s where AI makes a real difference.

By automating clinical documentation, coding, billing, and denial management, AI lifts the weight of repetitive tasks off clinical and administrative teams.

As value-based care becomes the new normal, the real differentiators won’t be more staff or longer hours—it’ll be smarter systems. Healthcare organizations that plug AI into their daily workflows are the ones setting themselves up to move faster, care deeper, and win on outcomes, cost, and clinician sanity.

Curious to see how Combinehealth’s AI agents can assist in your VBC initiatives? Book a demo!